Details disputed in condition of patient who died after abortion

By Andrea K. Walker, The Baltimore Sun

A Baltimore abortion clinic whose license was suspended last week disputes that a patient suffered cardiac arrest at its facility, as the state contends.

The administrator for the clinic, Associates in Ob/Gyn Care LLC on North Calvert Street, said in a letter dated March 8 to state health officials that the patient began having trouble breathing while recovering from an abortion and was taken to a local hospital, where she eventually died.

The patient suffered from a fatal heart condition, may have had defective heart valves and was probably in heart failure, the administrator, Melissa Shachnovitz, wrote in the letter, which the clinic provided to The Baltimore Sun.

The letter to Health Secretary Joshua M. Sharfstein came in response to the license suspension, which prohibits the clinic from performing surgical abortions. The facility is still open for general ob/gyn services and non-surgical procedures.

The suspension was one of the first actions the state has taken since adopting regulations for abortion clinics eight months ago. Created in part because of a botched procedure at an Elkton clinic in 2010, the regulations allow the state to fine or shut down a clinic for violations related to anesthesia, emergency services, lab work and other areas.

Several delegates pressured state health officials in recent weeks after a New York teacher died at a Germantown facility last month, complaining that the state was not inspecting clinics quickly enough.

Health officials said they couldn't disclose details about what happened to the woman at the Baltimore clinic because of privacy laws, which extend to patients even after they die.

"Both to protect the privacy of patients at the facilities and because the regulatory process is still underway, the Department cannot comment further at this time," the Department of Health and Mental Hygiene said in a statement.

The clinic can contest findings and sanctions, the statement said.

Health officials said in a letter to the General Assembly last week that they suspended the license of the Baltimore facility because the physician who performed the abortion wasn't certified in CPR and the defibrillator at the clinic did not work.

Although the woman's death was caused by underlying conditions and not the abortion, state investigators found that the incident raised questions about whether doctors at the clinic could handle an abortion that goes wrong.

The surgical abortion licenses of two other clinics run by the company, in Silver Spring and Landover, were also suspended.

Investigators observed a patient at the Silver Spring clinic who was left alone for three minutes after waking up, leaving her at risk of falling. At the Landover location, the nurse did not know how to use the defibrillator or suction machine, and the defibrillator pads had expired.

A spokeswoman for the clinics said the company had corrected the issues at all three facilities. The defibrillators were fixed and staff retrained. They also performed emergency drills.

The clinics won't be allowed to perform surgical abortions again until the state agrees that they've fixed the problems.

In the letter to Sharfstein, Shachnovitz also contested that the patient at the Baltimore facility suffered cardiac arrest.

Shachnovitz said she felt the need to respond in detail because state inspections are public record. She worried that anti-abortion activists would use the findings against the clinic.

"We feel that it is necessary to defend our reputation against false impressions," she wrote.

In the letter, she detailed what happened to the patient.

However, the letter also says some of the information about the patient's health was secondhand and could not be confirmed. The account came "from observations of the patient by the clinic's physician and CPR-certified registered nurse and from conversations with physicians in the hospital where the clinic said the patient was taken.

"Some of this information is second-hand and cannot be verified by us; however, this is the most accurate information that we have about this patient to date," the letter said.

Shachnovitz described the woman in the letter as an immigrant from a remote area in a Third World country who hadn't seen a doctor in years and probably didn't know she had the fatal heart condition cardiomyopathy — a heart muscle deterioration that leads to heart failure.

The woman received a first-trimester surgical abortion and was sedated, but conscious during the procedure, which was completed in eight minutes with no complications, the letter said.

During recovery, the patient began having problems breathing. The doctor ran into the room and performed mouth-to-mouth resuscitation, the letter from the clinic said.

Clinic spokeswoman Bridget Wilson said the doctor hadn't renewed her CPR certification, but knew how to perform the procedure.

"Our physician's fast response and proper care temporarily saved the patent's life, and resulted in her safe transport to the hospital," Wilson said in an email.

Shachnovitz wrote that the patient stayed in the hospital for several days before dying. She said the patient arrived at the hospital with pulmonary edema — fluid on the lungs that can cause trouble breathing. The edema was likely caused by a pulmonary embolism — a blockage of an artery in the lung — or "some other respiratory insult," she wrote in the letter.

While in the hospital the patient also developed pressure in the brain, which, the letter said, led to the patient's death.

Shachnovitz contended in the letter that it is not certain the patient's death was even related to the abortion, suggesting that her condition might have made it inevitable that she would release a blood clot.

"The mere fact that it occurred while she was sitting in our facility recovering after an abortion procedure may possibly have been simply a coincidence," she wrote.

Wilson could not confirm what information was secondhand and what was confirmed, except that the clinic doctor said there was no cardiac arrest.

The Cecil County state's attorney's office withdrew all charges Tuesday in the murder prosecutions of Nicola I. Riley and Steven C. Brigham, the first doctors charged under Maryland's fetal homicide law in a case involving a medical procedure.